DESCRIPTION: Major concerns exist about the quality of care being delivered in the U.S. health care system in general and in the nursing home sector specifically. It has been suggested that working conditions such as staffing levels, the physical environment, workflow design, and organizational culture may effect the ability of health care workers to provide safe and effective care. Rapid growth in the number of older persons is expected to occur over the next 20-30 years, with approximately 5% of persons aged 65 years and older residing in a nursing home at any one time. It is imperative that the factors associated with poor outcomes in nursing homes be better understood, so that appropriate quality improvement programs can be designed and successfully implemented. Nursing homes present a unique challenge in the consideration of organizational performance and how this performance may need to, be improved. They are highly regulated, primarily for-profit, and staffed in large part by non-professionals. It is our belief that the? nursing home culture and the interactions that occur among nursing home staff play an important, if not vital, role in the ability of the nursing home to deliver high quality care. The purpose of this exploratory study is to describe selected working conditions ? in the nursing home and to determine what relationship these selected conditions have to nursing home performance. The specific aims of this study are: 1) determine the frequency and variability of selected working conditions (culture and environment, staff interaction, and staffing) among a sample of Colorado nursing homes; 2)-determine the frequency and variability of targeted organizational performance measures (MDS Quality Indicators, state survey citations and complaints filed with the state, and perceived effectiveness); 3) examine the relationship between selected working conditions and targeted organizational performance measures and; 4) elicit an in-depth description of organizational culture (rituals, heroes, celebrations) from key informants and explore their relationship to quality care. Data related to nursing home working conditions will be gathered via surveys of all nursing home staff, interviews of key informants, and using the Observable Indicators of Quality Scale. Performance measures will be collected using staff surveys of perceived effectiveness, quality indicators from the Minimum Data Set (MDS) Resident Assessment, state survey citations and complaints filed with the state. Thirty-six nursing homes will be selected for the study using a stratification process based on 3 MDS quality indicators.